Chaire Santé

"Purpose: To analyze the associations between increased residual disability among poststroke survivors and the repercussions for their informal caregivers’ lives, taking into account the latter’s gender and education level.

Methods: 215 stroke survivors (64.5 years; 55.8% men) were recruited by one neurologist from each of the 22 French regions. Katz Index of Independence in Activities of Daily Living (Katz ADL) was mean 9.3, and 54% still had impairments in “more than two of the six neurological domains” of the American Heart Association Stroke Outcome Classifi cation (AHA.SOC): motor,
sensory, vision, affect, cognition, and language. The 215 caregivers (57.8 years; 72.1% women) completed a face-to-face questionnaire concerning their social (8 items), material (4 items), and emotional (8 items) repercussions.

Results: Katz ADL and AHA.SOC were significantly related to social repercussions for caregivers. Lack of autonomy among stroke survivors (low Katz ADL) was associated with the material diffi culties of most concern to caregivers: “I needed to move house” (odds ratio [OR] 1.16; 95% CI, 1.07-1.27) and “I cannot go out anymore” (OR 1.29; 95% CI, 1.16-1.44). Being a male caregiver was strongly associated with a feeling of injustice (OR 2.53; 95% CI, 1.07-6.00). A low educational level was linked to an increased feeling of fear (OR 2.61; 95% CI, 1.05-6.51) and a greater feeling of isolation (OR 6.49; 95% CI, 1.20-35.02).

Conclusion: Increased dependency post stroke leads to impoverishment in the caregiver’s social relationships. Evaluating
the emotional repercussions, particularly for men, is an important aspect of enabling survivors to continue to live at home. Innovative accompaniment and counseling services should be considered.

Key words: cardiovascular accident, caregivers,
gender, level education, repercussions, stroke"

"Resumen

El artículo aborda la cuestión de la salud mental en el exilio, tomando como base el análisis discursivo de las entrevistas socio-biográficas a una de las usuarias de EXIL-Barcelona (centro de salud mental especializado en las secuelas de la violencia organizada) y del conjunto de entrevistas focalizadas a los profesionales del centro. Primero, examina las narraciones etiológicas profanas y los elementos constituyentes del itinerario de salud. A continuación, analiza la terapéutica del centro. El artículo reflexiona sobre los procesos de subjetivación de la violencia organizada, cuyas dolorosas secuelas se tratan de aliviar en EXIL-Barcelona, a través de un proceder terapéutico que promueve un modelo de ciudadanía. Las conclusiones enfatizan el trabajo moral subyacente en el ars medicus.

Palabras clave: Salud mental, exilio, violencia, Sindrome de Estrés PosTráumatico, trabajo moral (5 palabras clave)

Abstract
This article approaches the issue of mental health in exile, based on the discursive analysis of the socio-biographical interviews to one of the beneficiaries of the mental health center specialized in the sequels of violence, EXIL-Barcelona and of the focus interviews to its staff. First, it examines the profane etiological narratives and the constituent elements of the healthcare path followed up to a violence-specialized mental healthcare center in Spain. It goes on to analyze the center’s therapeutics. The article explores the processes of subjectivation of organized violence, whose harmful sequels EXIL-Barcelona seeks to relieve by means of a therapeutic that promotes a model of citizenship. The conclusions emphasize the moral work underlying ars medicus.

Key words: Mental Health, exile, violence, Post-Traumatic Stress Syndrom, "

Background: Life satisfaction of stroke survivors is known to be associated with socio-economic factors and the survivor’s and his/her caregiver’s quality of life, but their respective influence remains to be fully elucidated. Purpose: To analyse the stroke survivors’ life satisfaction 2 years after the event and its relationships with quality of life, socio-economic and stroke-related characteristics, and with informal caregivers’ life satisfaction and quality of life . Methods: Over 18 months, all stroke patients from Luxembourg and north-eastern Portugal who lived at home were identified from the Inspection Générale de la Sécurité Sociale and hospital records, respectively. The clinical diagnosis of cerebrovascular disease was confirmed. We excluded all patients who declared that stroke did not result in neurological impairments at the time of stroke from the statistical analysis. The samples comprised 79 patients in Luxembourg and 48 in Portugal. Patients and the people they identified as their main caregivers were interviewed using validated questionnaires measuring life satisfaction, i.e. the Newcastle Stroke-Specific Quality of Life (Newsqol – 11 subscales), which identifies the areas affected by stroke among patients, and the World Health Organization Quality of Life – bref (Whoqol-bref – 4 subscales) of informal caregivers. Survivors without neurological impairment at the time of stroke were excluded. Data were analysed via multiple-regression models. Results: Life satisfaction was higher among women and lower among subjects with impaired motor functions. It was lower among Portuguese respondents with low-level education (<12th grade) and higher among those at work (37.6/100). In Luxembourg, retired people had more life satisfaction than did working people (–7.9/100). Controlling for socio-economic factors, life satisfaction was associated with feelings- Newsqol (slope 0.25) among Luxembourg residents, and with feelings-, mobility- and self-care-Newsqol (slopes 0.24, 0.27 and 0.33, respectively) among Portuguese respondents. Life satisfaction of patients was strongly related to that of family caregivers among the Portuguese respondents (slope 0.66) but the relationship was moderate in Luxembourg (slope 0.28). The survivors’ life satisfaction was not correlated with any Whoqol-bref domain in the Luxembourg group, but was correlated with the Whoqol-bref psychological, social relationships and environment domains among the Portuguese respondents (slopes 0.55, 0.59 and 0.51, respectively). Conclusions: The life satisfaction scale and the Newsqol stroke instrument, which identify areas of quality of life affected by stroke, are reliable patient-centred markers of intervention outcome. They can be used within the framework of medical follow-up (such as telephone assistance, clinical practice and prevention). Depending on the stroke survivor’s and the family caregiver’s habitual lifestyle and material circumstances, enhancement of a caregiver’s quality of life can help maintain the patient’s life satisfaction, particularly in a rural setting.

Thesis published online, in spanish :
"La enajenación de l@s otr@s. Estudio sociológico sobre el tratamiento de la alteridad en la atención a la salud mental en Barcelona y Paris." [ISBN: B-24362-2006/84-689-8876-6/] TDX 0718106-135329]
http://www.tdx.cat/handle/10803/5125;jsessionid=4C3A230217D0A8869E0788D5D7C35EDE.tdx2
Pp. 1-370 (Annexes i-xxxiii)

In my PhD thesis I have analyzed the social discourses that conceive the otherness as a challenge to healthcare provision. It takes as contemporary scenes of social heterogeneity, France and Spain. To obtain an in-depth analytical approach, it confines its scope to Paris and Barcelona and, the fieldwork is centred on nine mental health services specifically addressed to non-UE immigrants and people in exile (sociological study of multiple cases). Accordingly, it seeks to embrace the variety of theoretical models and therapeutic practices regarding the alienated otherness, in both cities. "The alienation of the others" is the metaphor that synthesises the topic of this research: it evokes the study of affliction and mental health problems, as well as, it emphases the construction of the subject as a stranger, requiring special treatment. By applying a socio-constructionist and critical theoretical and methodological perspective, this research seeks to explain 'the social production of otherness' and understand the reasons why the relationships between heterogeneities are as they are. It tries to discern the logics of the processes of integration/exclusion, in which the monopolisation of the resources of knowledge/power plays a key role.
The argumentative line of this PhD thesis is founded upon the interrelation of three conceptual axes: "otherness", "health" and "biopolitics". It proposes a conception of "otherness" as relative and relational, produced by the social distinctions that arise from the dialectics between the world of similarity (the identical and its equivalences) and the world of difference (the different and its divergences). Consubstantial to all human groups, its content is however, historically variable and socially shaped. Otherness evokes differences as well as unequal power relationships. The categories of otherness taken into consideration here are related to the EU construction and the widening gap between Centre and Periphery, whose geopolitical and socioeconomic configuration takes root in Colonial History. The reason why this study locates the analysis of the otherness into the field of health responds to the fact that research on health are extremely persuasive at rendering social inequalities visible: 1) in front of diseases and death, human beings are unequal and 2) the dimensions that structure the social position and determine the 'universes of social opportunities" (volume and structure of capitals) exert effects on the biological nature of the being. Health is the tropo (common place) of the interrelation of the physical-psychic being (biological dimension of the difference) and the social and political world (social and political dimension of inequalities). Biopolitics give a fruitful framework to base this research object.
To sum up, this PhD thesis gives an answer to the following questions:
I. What explains the launch of healthcare services specifically addressed to non-EU populations within national health systems whose access and medical care are based on the principles of universalism and equality?
II. Which are the consequences in terms of health inequalities that produce a differentialist (and, in some cases segregationist) approach to assess and manage non-EU population's health needs?
III. Which is the configuration of the power relations between heterogeneities that is underlying the different models of interpretation and treatment of the alienated bodies' mental health?
I have sought to conduct a sociological research that brings together "the critical" (to put into question the principles that structure knowledge), "the crisical" (to take conscience about its own limits) and "the creative" (social and politics implications of discourses). In doing so, I looked for going beyond a conventional sociology of health and illness, able to approach the object of study with a sociology of knowledge that is extremely conscious of the political and ethical dimension of the research process itself.

English:
Recognized as "ethnic minorities" by the Council of Europe since 2005, the "Roma", "Gypsies " or " Travellers " have in common an experience of living at the margins, which indeed takes diverse forms according to national contexts. Such experience comes within the scope of UE extension and the construction of its borders. As this collective book aims at unravelling the logics underpinning this experience, the position this population occupies is referred here with the term of "the inner-foreigners". The authors analyze, within different European contexts (Belgium, Spain, France, Rumania), how categories are produced and mobilized by the actors (professionals and/or lay people) in the fields of education, social welfare and healthcare. They also expound the effects of this double process of production and mobilisation of categories. Furthermore, they shed light on the power relations that are inherent to the act of naming a population – which is de facto very heterogeneous - as well as led by State-specific political dynamics. This issue is approached from the point of view of both the governments and those who mobilize them (e.g., the cases of Gypsy women's associations in Spain and of the Rudari in Rumania illustrated here). Last but not least, this book invites us to exercise a critical, respectful and open to the plurality perspective, while offering tools addressed to professionals in contact with stigmatised minority populations.

French:
"Reconnues depuis 2005 comme « minorités ethniques » par le
Conseil de l’Europe, les « Rroms », « Manouches», « Gitans » ou « gens du voyage » ont en commun une expérience de la marge qui prend diverses formes selon les contextes nationaux et s’inscrit en même temps dans le contexte de l’élargissement européen et de la construction de ses frontières. Dans le but de dégager les logiques de cette expérience, nous proposons d’appeler la place qu’occupe cette population, celle
de « l’endoétranger ». Les contributions de ce volume analysent dans divers contextes européens (Belgique, Espagne, France, Roumanie) comment les catégories sont produites et mobilisées par les acteurs (professionnels et/ou publics) dans le domaine de l’éducation, de la protection sociale et des soins, et quels sont leurs effets. Les enjeux de pouvoir inhérents à l’acte de nommer une population, de fait hétérogène,animé de dynamiques politiques spécifiques aux États, sont mis en lumière tant du point de vue des gouvernements que de ceux qui les mobilisent (e.g. le cas des associations de femmes gitanes en Espagne ; des Rudari en Roumanie). Ainsi, cet ouvrage invite à exercer une pensée
critique et à développer un argument respectueux et ouvert à la pluralité tout en offrant des outils mobilisables par les professionnels."

Quels objets, quelles méthodes, quels concepts pour les sciences sociales de la santé et de la santé mentale ? Nouveaux troubles et pathologies émergentes Colloque organisé par Nadia GARNOUSSI et Maïa FANSTEN Cermes 3, Centre d' études médecine, sciences, santé, santé mentale, société (UMR 8211 -U988) http://troublesconf13.sciencesconf.org/ Université Paris Descartes Salle de conférences R229, Bâtiment principal, 2e étage 45 rue des Saints-Pères, Paris 6 e (Métro Saint-Germain-des-Près)

Après sept ans de démarches, concertations, négociations, relogements provisoires, vingt-huit familles roms vivant en bidonville ont pu s’insérer dans les dispositifs de droit commun, qu’il s’agisse du logement, de l’emploi, de la scolarisation ou de la santé. Une des rares initiatives réussies dans un contexte de pénurie de logement social et de montée de la xénophobie.

Plan de l'article
Des « Roms » au centre névralgique de la cité
D’émigrés de Cheveresu Mare à Roms à Sénart
Une confiance émoussée
Les trois clés d’une victoire ardue

Desde mediados de la década de 1990, se ha perfilado, en el marco de los estudios sobre migraciones en España, una importante línea de trabajo que pretende dar cuenta de los procesos de construcción social del «inmigrante» en tanto que figura social de la alteridad. En este artículo, y desde una perspectiva construccionista y dinamista, hacemos un alto en el camino con el objeto de re-pensar cómo se está estudiando la construcción social de las alteridades vinculadas a las contemporáneas situaciones migratorias, y, tras constatar que, en dichos estudios, predomina lo que se ha dado en llamar una «gramática orientalista », apostamos por una complejización de las estrategias explicativas de los procesos identitarios, o de sus correlatos, los alteritarios.

L’article se centra en la gestió de la diferència en la sanitat
pública prenent com a punt de mira la política sanitària a Catalunya referent als col·lectius d’immigrants extracomunitaris. L’anàlisi dels documents de planificació sanitària a escala autonòmica i l’estudi de les polítiques locals i les iniciatives socials del sector voluntari porten a sostenir la doble tesi de l’estatalització de l’accés a l’atenció a la salut de les persones
immigrants en situació de regularitat administrativa, o, en el seu
defecte, de les persones registrades al padró municipal, i la comunitaritzacióde la cura de la malaltia de les persones immigrants no empadronables. Aquest estudi qüestiona  el principi d’universalisme que formalment regeix el sistema sanitari públic.

Resum: L'objectiu d'aquest article és presentar la teoria matemàtica dels conjunts borrosos com a eina de tractament de dades en el camp de les ciències socials. En primer lloc, exposem una reflexió entorn d'algunes de les qüestions metodològiques que ens preocupen respecte al procés de la investigació científica. En concret, aital preocupació metodològica gira entorn dels temes d'incertesa, veritat, validesa i informació, temes que ens porten a proposar la pertinència de la teoria dels conjunts borrosos a mode de mètode per al tractament de la incertesa en les ciències socials. En segon lloc, exposem una breu descripció de la teoria dels conjunts borrosos, en la qual indiquem llurs elements més fonamentals. Seguidament, oferim un exemple d'aplicació d'aquesta teoria matemàtica utilitzant les dades extretes d'una enquesta realitzada als membres del Parlament de Catalunya sobre la Llei 1/1998 de política lingüística (7 de gener de 1998).

Este texto es la transcripción, a modo de discurso vertebrado, de la entrevista realizada a la antropóloga Dolores Juliano (Universitat de Barcelona. Departament d'Antropologia) sobre los temas más relevantes de los diversos artículos que constituyen este monográfico. La entrevista fue realizada por Kàtia Lurbe (Universitat Autònoma de Barcelona. Universidad de Wanwick) el 23 de septiembre de 1999.

Work migration from poor to rich countries is one of the consequences of globalization processes. While health represents a central dimension of migration, access to health care services is one of the obstacles migrants workers have to cope with in their countries of arrival. This is especially so for undocumented migrant workers arriving to countries in which access to health care services depends on legal residency. The present paper compares undocumented migrants' access (or lack of access) to health care services in Spain and Israel, emphasizing the mechanisms by which they are included to or excluded from access to the different levels of health care.